Thousands of persons every year undergo surgery to replace a diseased or damaged joint with a prosthesis. That one can have a diseased or damaged joint, such as a hip or knee, removed and replaced on one day, and then be up and walking the same day, seems a miracle to the casual observer; yet it happens every day. This miracle is a testament to the combined ingenuity of the prosthesis engineers and the skill of the orthopedic surgeons and their surgical team. Working together, prosthesis engineers and orthopedic surgeons continually improve their craft every year, developing new prosthetic devices, new instruments to install them, and new surgical procedures. It is an evolving science and an art form.
To be sure, orthopedic implant surgery, such as replacement of a human joint with a prosthetic joint, is a highly specialized and demandingly complex process. An orthopedic surgeon will typically learn his or her craft during a fellowship under the tutorage of a master surgeon. The new surgeon will then go on to become a master surgeon as well, further improving the surgical craft and passing that knowledge on to others.
The basic procedures for replacing a joint with a prosthesis generally follow an established workflow that is dictated by the physical geometry of the prosthesis and the human body. However, because no two patients are exactly alike, no two joint replacement surgeries will be exactly alike. Thus each time the surgeon opens up the patient with the first scalpel cut, the surgeon must be prepared to make countless in situ decisions: cut 2 mm deeper here, abrade bone spurs there, use antibiotic-infused cement, don't use antibiotic-infused cement, the list goes on and on. In short, the surgeon must make countless split second decisions and must be prepared to improvise based on what he or she finds once inside the patient.
In many respects the orthopedic surgeon is like a professional basketball player. His moves are highly skilled, the path to the goal involves many judgment calls and split decisions, and most importantly, the surgeon works as part of a team. To be successful each member of the surgical team must perform his or her job with precision, always mindful of the surgical objective, and always mindful of the surgeon's surgical preferences. If the surgeon needs a wider opening in which to insert the reamer, the surgical team member must instinctively know to pull a bit tighter on the number 6 retractor, for example. If the surgeon likes to assess the position of a cutting block before making an important cut, the surgical team member anticipates this and hands the surgeon the fluoroscopic instrument, if that is the surgeon's preference. There are of course countless variations. A different surgeon might prefer to make a longer cut to ease insertion of the reamer; or might prefer to position the cutting block by manually sensing its position with the fingers.
Quite simply, a well-trained, well-rehearsed surgical team who understand the procedures and know the surgeon's preferences will allow the surgeon to replace a diseased or damaged joint with a prosthesis in the shortest possible time. Making the surgeon more efficient saves cost, allows the surgeon to perform more surgeries per day, and quite importantly, it shortens the length of time the patient lies in the operating room with an open wound exposed to the elements.
While the well-trained, well-rehearsed surgical team is certainly the goal, there is a large practical problem that must be overcome. Hospitals typically supply the surgical nurses and these nurses may be assigned to work for a large number of different surgeons, including surgeons with other orthopedic practices. There has heretofore been no practical way for hospital-supplied surgical nurses to efficiently and effectively learn individual surgeon preferences, and thus it is rare that any given hospital-supplied surgical team will ever approach optimal efficiency.